In all industries, the last several decades have seen an evolution in the role of the executive in charge of information technology: the chief information officer. Today the CIO is viewed as an important contributor to the organization’s strategy who ensures that applications, infrastructure and analytics support the day-to-day operations of the organization.

In health care, the College of Healthcare Information Management Executives has chronicled and guided this evolution. CHIME notes that the job description of the technical manager responsible for IT operations now calls for competencies in vendor management, large project management, technology interpretation, managing change, customer service and innovation.

The abilities and talents required for the CIO position also have become more substantial. CIOs must be leaders, develop and manage great teams, possess terrific communication skills, establish credibility and trust, be adaptable and have a deep understanding of the organization’s business as well as the IT industry.

This decades-long evolution has been characterized as a progression from technology manager to CIO 1.0, to CIO 2.0. Each stage of the progression places new demands on the CIO while preserving the demands of prior stages.

As we undergo substantial transformation in health care, the next step in the evolution of the CIO will occur — it’s dubbed “CIO 3.0.” The CIO 3.0 will be shaped by five factors.

The Transformation of the Health Care Business Model

Reactive sick care is being replaced by proactive efforts to keep people well and out of the hospital. Fragmented care delivery capabilities are being supplanted by initiatives to create and manage cross-continuum systems of care. Providers that were rewarded for volume are increasingly being rewarded for quality and efficiency.

New forms of reimbursement such as bundles and various types of capitation are causing the shift in the business model. To thrive under the new models, providers are creating health systems that include venues along the care spectrum. They are also introducing new processes to support the need to manage care between encounters, keep people healthy and ensure that utilization is appropriate.

For the CIO steeped in inpatient care, knowledge of hospital operations must expand to include knowledge of the operations and needs of long-term care facilities, patient support communities and small physician practices. An understanding of the intricacies of fee for service must expand to include payments based on bundles and capitation.

This knowledge must have some depth. It will not be enough to say the words “population management”; the CIO will need to understand how such management really works, have a clear understanding of the associated IT needs and appreciate the gains in health that are possible vs. those that are not.

Skills in managing complex implementations still will be necessary, but those skills must broaden to include redesigning processes that traverse care settings, tuning clinical decision support logic to achieve chronic care outcomes, and assisting clinicians and managers in developing the analytics capabilities necessitated by new payment arrangements.

The Relentless Innovation in Information Technology

Information technology innovation continues at a remarkable pace. The Internet of Things is creating a reality of intelligent homes, cars and equipment — environmental sensors and devices attached to patients. Social media use continues to grow and become more sophisticated and capable. Mobile personal devices have become the device of choice for personal and professional activities. Big data has exceptional potential, although it is cloaked in a dense fog of hype.

The CIO must be able to educate the organization’s leaders and discuss the strengths and weaknesses of electronic health record vendors, the opportunities enabled by the Internet of Things, the maturity of population health technologies and the state of big data approaches.

Moreover, to an unprecedented degree, IT now sits at the foundation of care delivery. The impressive surge in meaningful use-induced EHR adoption has resulted in the vast majority of providers becoming dependent on IT for clinical operations and patient care. Initiatives designed to enable the organization to manage populations and care over a continuum are not possible without the implementation of a new category of IT applications that complement traditional IT investments.

The transformation of the industry means that IT is no longer a necessary back office evil — it is  an essential foundation if an organization is to thrive. That has not been true in the past; provider organizations could do quite well in a fee-for-service world without computerized provider order entry and other advanced IT applications.

On top of all this is the menace of hacking, thefts of large amounts of data, and the ability of malevolent individuals and nations to disable applications and cripple the ability of an organization to function.

These advances in IT require that the CIO become conversant in the capabilities, maturity and potential contribution of a wide range of new information technologies. In addition, the organization’s dependence on IT for it to function heightens the importance of a well-managed and secure IT infrastructure and application base.

A Shift in Strategic Emphasis

In many ways, the last several years have seen the health care field lay the foundation for a transformed health care system. Meaningful use has led to the broad implementation of EHRs and an increase in the exchange of patient data among providers. Health care providers have engaged in a wave of consolidation leading to the creation of multivenue health systems. Most providers have embarked on various forms of risk arrangement.

With the core of the foundation in place, providers are now in a position to transform care at scale by, for example, moving from managing the chronic diseases of their employees to managing chronic diseases of the community.

For the health care CIO, this means a shift from focusing on the large-scale implementation of EHRs to extending that investment to support care management, enabling the management of a population’s health, introducing extensive evidence-based decision support, developing superior analytics capabilities, creating and redesigning processes, and improving the efficiency of clinical and administrative processes.

This is a shift away from making the foundational investment and toward obtaining the return from that investment.

Stepping Up Skills and Attributes

CHIME surveys have identified several personal characteristics of effective CIOs. Examples include emotional intelligence, communication skills, integrity, business understanding, and the ability to hire, grow and manage a world-class team.

These characteristics have been attributes of effective CIOs for many years. However, with every stage in the evolution, the increasing strategic and operational importance of IT has meant that these characteristics had to be present and performed at even higher levels. In a similar fashion, the performance of athletes in the 2016 Olympics must be higher than the performance at the last Olympics.

A level of performance that might have earned a CIO a letter grade of A 10 years ago will earn him or her a B or even a C in the next stage.

In addition to a higher bar on interpersonal characteristics, the CIO must grapple with the exacerbation of several problems (identified by the Cash Catalyst LLC) that confront the IT executive:

·      CIOs must emphasize speed to value while implementing and managing infrastructure. IT leaders must innovate while delivering bulletproof systems. CIOs need to have great vision while being great managers who deliver IT systems and services that are top-notch.

·      IT executives must enable others to apply IT while controlling budgets and enforcing standards. CIOs must work with leaders to understand the potential of IT while working with the IT team to understand the business.

IT Leadership Becomes a Team Sport

As the sophistication and impact of the technology deepens, the competencies and background required to ensure that the technology is implemented and used well also deepen. This has led (and will lead) to new senior IT leadership roles that concentrate on a particular aspect of the technology.  

The chief medical information officer has been created to further the ability of the organization to work with physicians on implementation and use opportunities and issues. Some organizations have established the chief nursing information/informatics officer to perform a comparable function with the nursing community.

In addition to these roles, we increasingly see the following:

·      chief information security officer to ensure that data and application safeguards are in place;

·      chief technology officer to manage technology assessments, infrastructure partnerships and IT architecture;

·      chief digital officer to address the use of social media and patient-facing applications; 

·      chief IT data officer to oversee data quality and capture data analytics.

The CIO will need to work effectively with other senior IT executives who have domain knowledge that is more substantial in a particular field. Moreover, sometimes these other roles do not have a direct reporting relationship to the CIO. For example, the CMIO may report to the chief medical officer.

In addition, as health care organizations become more experienced with IT, other members of the C-suite have become much more facile with identifying IT opportunities and ensuring that implemented systems deliver desired organizational gains. For example, CFOs are now much savvier about IT than they were 10 years ago. These executives are becoming comfortable making IT decisions that were previously the purview of the CIO.

Hence, as the CIO must learn to share IT leadership with multiple other executives, IT leadership increasingly will be collaborative leadership.

A Transition of Degree

Several significant factors are shaping the health care CIO 3.0: the transformation of the health care business model, continued advances in information technology, the shift in emphasis from EHR implementation to harvesting the investment, the need for excellent interpersonal attributes and skill to achieve a higher bar of performance, and skillfully managing and working with the extended executive IT team.

The transition from the back-office technical manager to an executive who is a valued member of the leadership team was a transition of “kind.” Those two roles are different and the individuals who can effectively fulfill those roles are also different.

The transition from the CIO 2.0 to CIO 3.0 is a transition of “degree.” Both roles require strategic technology understanding, excellent C-suite working relationships, management of large implementations, terrific communication skills and the ability to create a superb IT team.

The characterization of the next shift as one of degree should not lead us to underappreciate the magnitude of the shift. The changes in each factor are substantive, the emerging health care business model is quite different from that of its predecessor, the diversity and potency of emerging information technologies has no parallel, and the collective impact of the factors is extraordinary.

To offer an analogy: As I look at the plans of two of my daughters to get married this year, I am reminded that this shift from dating to marriage is a shift in the degree of commitment. No one doubts the magnitude of that shift. And no one doubts the importance of ensuring that the shift in degree is successful.

John Glaser, Ph.D., is a senior vice president with Cerner in Kansas City, Mo. He is also a regular contributor to H&HN Daily.